NDC 121479905
Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
levETIRAcetam 500 mg Soln-Oral 5 mL
Reported by 4 hospitals in the network under the case rate methodology.
Low
$11
Average
$13
Median
$11
High
$21
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Reflects a negotiated flat case rate paid per episode of care, rather than itemized charges.
| # | Hospital | ||||||
|---|---|---|---|---|---|---|---|
| 1 | Northwest Sahurita Hospital LLC Tucson, AZ | $11 | $11 | — | — | — | $1 – $11 |
| 2 | Northwest Sahurita Hospital LLC Sahuarita, AZ | $11 | $11 | — | — | — | $1 – $11 |
| 3 | Northwest Hospital LLC Tucson, AZ | $11 | $11 | — | — | — | $2 – $11 |
| 4 | The Trustees of the University of Pennsylvania D/B/A The Hospital of the University of Pennsylvania Philadelphia, PA | $21 | $21 | — | — | — | $4 – $21 |
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